Manifestations Of Gastroesophageal Reflux Disease Research Articles

Gastroesophageal reflux disease in children: What's new right now?

Gastroesophageal reflux (GER) in children is very common and refers to the involuntary passage of gastric contents into the esophagus. This is often physiological and managed conservatively. In contrast, GER disease (GERD) is a less common pathologic process causing troublesome symptoms, which may need medical management. Apart from abnormal transient relaxations of the lower esophageal sphincter, other factors that play a role in the pathogenesis of GERD include defects in esophageal mucosal defense, impaired esophageal and gastric motility and clearance, as well as anatomical defects of the lower esophageal reflux barrier such as hiatal hernia. The clinical manifestations of GERD in young children are varied and nonspecific prompting the necessity for careful diagnostic evaluation. Management should be targeted to the underlying aetiopathogenesis and to limit complications of GERD. The following review focuses on up-to-date information regarding of the pathogenesis, diagnostic evaluation and management of GERD in children.

Hypervigilance and Anxiety are Elevated Among Patients With Laryngeal Symptoms With and Without Laryngopharyngeal Reflux

Most patients experiencing laryngeal symptoms are labeled as having laryngopharyngeal reflux (LPR).1 LPR has classically been defined as an extraesophageal manifestation of gastroesophageal reflux disease (GERD) in which gastric refluxate leads to irritation of and increased nociception at the upper aerodigestive tract.2 Diagnosis of LPR poses a significant challenge to clinicians and patients. For instance findings on laryngoscopy graded according to the validated reflux finding score are nonspecific for LPR because multifactorial etiologies including postnasal drip or allergies can result in an elevated reflux finding score.

Chronic aspiration bronchiolitis in a patient with esophageal diverticulum and gastroesophageal reflux disease

Purpose of the study: to present a description of the clinical observation of chronic aspiration bronchiolitis in a patient with a large diverticulum of the upper esophagus and gastroesophageal refl ux disease (GERD).Materials and methods: a brief review of the literature on the modern concept of extraesophageal respiratory manifestations of GERD, the features of the course of upper esophageal diverticula, clinical and radiological symptoms of chronic aspiration bronchiolitis is presented. In the above clinical case, chronic aspiration bronchiolitis was a manifestation of gastroesophageal pathology.Results: The development of fi brosing interstitial lung disease in a patient with a large upper esophageal diverticulum and GERD is presented.Conclusion: the problems of differential diagnosis of respiratory symptoms in esophageal pathology are shown. The authors hope that the described observation will increase the attention of doctors regarding comorbid fi brosing interstitial lung diseases in esophageal pathology; the need for timely detection of a progressive fi brotic phenotype and determination of indications for antifi brotic therapy.

Revision paraesophageal hernia repair outcomes in patients with typical and atypical reflux.

Revision laparoscopic anti-reflux surgery (RLARS) is effective in alleviating the typical symptoms of gastroesophageal reflux disease (GERD). RLARS outcomes in patients with atypical GERD symptoms has not been well established. A composite Reflux Symptom Index (RSI) score greater than 13 indicates extraesophageal manifestation of pathological reflux. In this study, we analyzed the differences in quality-of-life (QOL) and perioperative outcomes between patients with atypical versus typical GERD who underwent RLARS. A retrospective review was conducted of a prospectively maintained database of patients with pathologic reflux who underwent RLARS from February 2003 to October 2019. The cohort was divided into two groups, those with typical versus atypical manifestations of GERD, as defined by their RSI score. Patients with a RSI score of > 13 were assigned to the Atypical group and those ≤ 13 were assigned to the Typical group. Patient QOL outcomes were prospectively followed using the RSI survey. Significance was defined by p-value less than 0.05. A total of 133 patients (Typical 61, Atypical 72) were included in the final analysis. The two groups were similar (p > 0.05) in mean age (58.1 ± 13.3 vs. 55.3 ± 15.5years), body mass index (29.6 ± 5.0 vs. 30.3 ± 5.4), female sex distribution (60.7% vs. 59.7%) and age adjusted Charlson score (1.76 ± 1.58 vs. 1.98 ± 1.94). The Typical group had a higher frequency of type III hiatal hernia (62.3% vs. 29.2%) and Collis gastroplasty (29.5% vs. 5.6%). The groups had similar rates of partial and complete fundoplication with similar median length of stay (Typical: 3.0 ± 3.4days vs. Atypical: 2.4 ± 1.7days). After a mean follow-up of 30.2 ± 33.6months, both groups reported similar rates of improvement in RSI outcome from baseline (58.1% vs 43.3%, p = .149). However, the RSI outcome at the latest follow-up for the Typical group was significantly better than the Atypical group after RLARS (2.8 ± 5.3 vs. 15.9 ± 11.1, respectively). Patients who undergo revision paraesophageal hernia repair with objective findings of GERD and subjective complaints of atypical reflux symptoms may show long-term improvement in QOL outcomes. However, these results are contingent on proper patient selection and a thorough work-up for pathological reflux in this population. Further research is needed to determine universal diagnostic criteria to assist in the early detection and surgical treatment of patients with atypical GERD.

TRACHEAL AND BRONCHIAL STENOSIS CAUSED BY CHRONIC UNCONTROLLED GASTROESOPHAGEAL REFLUX DISEASE

TRACHEAL AND BRONCHIAL STENOSIS CAUSED BY CHRONIC UNCONTROLLED GASTROESOPHAGEAL REFLUX DISEASE

Pepsin and the Lung—Exploring the Relationship between Micro-Aspiration and Respiratory Manifestations of Gastroesophageal Reflux Disease

Gastroesophageal reflux disease (GERD) is one of the most commonly encountered disorders in clinical practice nowadays, with an increasing burden on healthcare systems worldwide. GERD-related respiratory symptoms such as unexplained chronic cough, bronchial asthma or chronic obstructive pulmonary disease (COPD) with frequent exacerbations often pose diagnostic and therapeutic challenges and may require a multidisciplinary approach. Moreover, a potential role of GERD as a risk factor has been proposed for chronic rejection in patients who underwent lung transplantation. Pepsin has gained considerable attention from the scientific community in the last few years as a possible surrogate biomarker for GERD. The aim of this narrative review was to provide an overview of the potential utility of pepsin detection as a marker of micro-aspiration in various biological fluids retrieved from patients with suspected GERD-induced respiratory manifestations and in lung transplant patients with allograft dysfunction. Data on the subject remains highly contradictory, and while certain studies support its applicability in investigating atypical GERD manifestations, at the moment, it would be realistic to accept a modest utility at best. A major lack of consensus persists regarding topics such as the optimal timeframe for fluid collection and cut-off values. Further research is warranted in order to address these issues.

Role of esophageal symptoms in the diagnosis of gastroesophageal reflux disease in children with recurrent and chronic respiratory diseases

Gastroesophageal reflux disease (GERD) is one of comorbid diseases, that worsen the course and outcomes of respiratory pathology. The study aimed to determine role of esophageal symptoms in the diagnosis of GERD in children with recurrent and chronic respiratory diseases (RCRD). The study included 125 children (70 boys, 55 girls), median 3,75 years (interquartile range, IQR – 1,21-9,38 years), with RCRD, refractory to standard therapy. GERD was diagnosed on the basis of clinical and complex instrumental examination, including fluoroscopy esophagus with contrast, esophagogastroduodenoscopy (EGDS), 24-hour esophageal pH-monitoring, dual pH-multichannel intraluminal impedance (pH-MII). In children with RCRD, the frequency of GERD was 86,4%. Among children without esophageal manifestations of GERD, pathological reflux was confirmed by instrumental methods in 81% of patients; in children with esophageal manifestations - 92%, with no statistically significant differences (p = 0,0637). Nonacid reflux is more common in patients without esophageal manifestations of GERD. The frequency of GERD in children with RCRD is very high. It is possible to screen GERD in children with RCRD, independent on the presence of clinical esophageal symptoms.

Gastroesophageal reflux disease and oral health: A narrative review

Gastroesophageal reflux disease (GERD) is a clinical condition in which stomach contents leak backward into the esophagus. It affects millions of people worldwide and has a detrimental effect on quality of life. Heartburn and acid regurgitation are typical GERD symptoms, while atypical manifestations include noncardiac chest pain, cough and laryngitis. The oral and maxillofacial manifestations of GERD may include dental erosion, xerostomia, mucositis, aphthous like ulcerations, sour taste, burning mouth, hyperesthesia, bruxism, and/or temporomandibular disorder (TMD). This narrative review provides oral health care professionals with an update to medical aspects of GERD, recognition and management of oral and maxillofacial manifestations of the condition and provision of appropriate dental care for this patient population.

Changes in serum somatostatin level and its association with calcium metabolism indicators in patients withgastroesophageal reflux disease and spinal injuries of degenerative-dystrophic andinflammatory genesis

Background. The study of clinical features, factors and levels of various biologically active substances that may play an important role in the pathogenetic mechanism of gastroesophageal reflux disease (GERD) in combination with degenerative-dystrophic or inflammatory lesions of the spine, is an extremely important problem of the modern medical community. The purpose of the research is to determine the peculiarities of changes in the level of serum somatostatin (SST) and its relationship with calcium metabolism in patients with GERD and spine lesions of degenerative-dystrophic and inflammatory genesis. Materials and methods. 84 patients with spinal lesions of degenerative-dystrophic or inflammatory genesis in combination with GERD were examined. The examined patients with GERD were divided into two groups depending on the form of spine injury. GroupI included 44 patients with osteochondrosis (OS) of the cervical and thoracic spine (SpA). Group II consisted of 40patients with spinal arthritis. Results. There was a significant increase in the level of serum SST in both groups of the studied patients with GERD and spine injury of degenerative-dystrophic or inflammatory origin. At the same time, a more pronounced deviation from the norm was detected in group II of patients (increase up to (0.756±0.027)pg/ml, p<0.01). Determination of level 25(OH)D in serum indicates vitamin D3 deficiency in patients with GERD and OS (decrease to (23.35±0.71) ng/ml, p<0.05) and its deficiency in patients with SpA (decrease to (18.66±0.52)ng/ml, p<0.01). Serum 25(OH)D levels also decreased more markedly in the atypical clinical course of GERD in the examined patients. Conclusions. In patients with GERD with degenerative-dystrophic and inflammatory lesions of the spine, an increase in the level of serum SST was found with the most pronounced deviation from the norm in atypical manifestation of GERD. A correlation between SST and a decrease in the level of 25(OH)D and Ca++, mainly in patients with atypical clinical course of GERD, was established.

Age-related features of gastritis activity in schoolchildren with gastroesophageal reflux disease

Aim. To study age-related features of the association of gastroesophageal reflux disease (GERD) with the activity of the inflammatory process in the gastric mucosa (GM) in schoolchildren. Materials and methods. At the first stage in the Republic of Tuva, we collected data on the presence of gastroenterological complaints in 1535 schoolchildren using a transverse method. At the second stage we performed esophagogastroduodenoscopy with biopsy of the mucous membrane of the antrum and the body of the stomach in two hundred forty six children including 76 cases aged from 7-11 years and 170 patients aged from 12 to 17 years. Morphological assessment of gastritis was carried out according to the Sydney classification after staining biopsy sections with hematoxylin-eosin; diagnostics of Helicobacter pylori - after staining by Giemsa method. The study was approved by the ethical committee and the consent of the surveyed patients was obtained. Results. An increase in the prevalence of GERD was found in the older age group of schoolchildren - 15.6% (7-11 years old - 4.7%; p = 0.0001). GERD schoolchildren showed an insignificant tendency with age to an increase in the activity of the inflammatory process in the mucous membrane of the antrum (p = 0.3408) and the body (p = 0.3346) of the stomach. Among infected GERD schoolchildren in both age groups, gastritis with a high degree (II-III degree) of activity was more often detected than in infected schoolchildren without clinical manifestations of GERD (7-11 years old - p = 0.2551; 12-17 years old - p = 0.0536, respectively) and more often than in those uninfected GERD cases (7-11 years old - p = 0.0082; 12-17 years old - p = 0.0002). The association of highly active forms of gastritis in the body of the stomach in infected schoolchildren with manifestations of GERD has not been established. Conclusion. The presence of GERD in schoolchildren, regardless of age, aggravates the course of the inflammatory process in the antrum. When infected with Helicobacter pylori, GERD and infection in schoolchildren act as factors that mutually aggravate the inflammatory process in the antrum.

Гастроэзофагеальная рефлюксная болезнь и коррекция ее проявлений у пациентов перед офтальмохирургическими вмешательствами

Purpose. Evaluation of the frequency of extraesophageal manifestations in the structure of gastroesophageal reflux disease (GERD) in patients admitted for ophthalmic surgery. Material and methods. The preoperative state of 76 patients with extraesophageal manifestations of GERD was analyzed. The assessment of the adequacy and effectiveness of drug therapy, algorithms for diagnosing extraesophageal manifestations of GERD is given, our own clinical case is presented to illustrate the complexity of diagnosing extraesophageal manifestations of GERD. Results. A group of 76 people with extraesophageal manifestations of GERD (21 %) out of 363 patients with GERD admitted for treatment in 2019 was studied. In 25 people (33 %), the extraesophageal form of GERD was not diagnosed before admission to the hospital. Of these, in 17 people GERD proceeded under the guise of cardiological pathology, in 8 people - under the guise of bronchopulmonary pathology. Conclusion. GERD occupies a leading position among diseases of the upper gastrointestinal tract (more than 30 %). About 21 % are atypical manifestations of GERD. Modern etiopathogenetic treatment of GERD makes it possible to effectively stop the symptoms of the disease, avoid polypharmacy, undesirable drug interactions and unreasonable refusal of planned surgical treatment for patients with ophthalmic diseases. Keywords: gastroesophageal reflux disease, extraesophageal manifestations, cardiological and bronchopulmonary “masks”, ophthalmic surgery.

Gastroesophageal reflux disease in patients with morbid obesity

Aim. To study the prevalence and manifestations of gastroesophageal reflux disease (GERD) in patients with morbid obesity based on endoscopic, X-ray findings and the function of the lower esophageal sphincter. Materials and methods. The study involved 98 obese patients with a mean body mass index (BMI) of 55.6 ± 10.3 kg/m2. Of these, 30 were men (34.48 %) and 68 were women (65.52 %) aged 18–64 years, mean age – 42.3 ± 8.5. All the patients subsequently underwent fibroesophagogastroduodenoscopy, esophagomanometry, 24-hour esophageal pH monitoring, X-ray examination and bariatric surgery. The presence and severity of pathological gastroesophageal reflux were assessed using esophageal pH monitoring data based on the DeMeester score. In addition, the lower esophageal sphincter function was assessed, the number of refluxes and the duration of the longest reflux episode were calculated according to the data of esophagomanometry and 24-hour esophageal pH monitoring. Statistical data processing was carried out using the StatPlus 2007 software package. Results. In this paper, we studied the prevalence and manifestations of gastroesophageal reflux in 98 obese patients. The mean BMI was 55.6 ± 10.3 kg/m2, the maximum was 72 kg/m2. GERD was diagnosed in 37 (37.76 %) patients, including 8 (8.16 %) patients with a hiatal hernia. The erosive form prevailed in the GERD pattern – in 24 (24.48 %) patients. In 32 (32.65 %) examined patients, pathological reflux was diagnosed during the daytime, especially after eating. Conclusions. The study results indicate that 37.76 % of obese patients are diagnosed with GERD arising from anatomical features and function of the gastroesophageal junction with the predominance of erosive forms of GERD. The state of the gastroesophageal junction in obese patients should be considered when choosing the optimal bariatric or metabolic surgery.

Особливості показників рН-моніторингу у хворих на ГЕРХ при поєднанні з дисфункцією сфінктера Одді

Стаття присвячена результатам вивчення поєднаного перебігу захворювань верхнього відділу шлунково-кишкового тракту — гастроезофагеальної рефлюксної хвороби та дисфункції сфінктера Одді. У результаті проведеного дослідження показано, що показники рН-моніторингу в дистальному відділі стравоходу прямо пов’язані з наявністю клінічних проявів, характерних для гастроезофагеальної рефлюксної хвороби. Також доведено, що зміни тонусу сфінктера Одді, незалежно від їх характеру, негативно впливають на перебіг гастроезофагеальної рефлюксної хвороби, обтяжуючи його.

Esophageal hyperkeratosis as uncommon manifestation of gastroesophageal reflux disease

We present the case of a 66-year-old woman with intermittent dysphagia and esophageal food impaction. The endoscopic examination showed an upper and middle esophagus with a diffuse circumferential, white, crackleware epithelium. Esophageal biopsies revealed acanthosis and papillomatosis with diffuse hyperkeratosis. High dose of Proton pump inhibitors was initiated with improvement of all symptoms 6 weeks later.

MANIFESTATIONS OF EXCESSIVE DAYTIME SLEEPINESS AND GHRELIN LEVEL IN CASE OF GASTROESOPHAGEAL REFLUX DISEASE IN PATIENTS WITH UNDIFFERENTIATED CONNECTIVE TISSUE DISEASE

The aim of the study was to discover the interrelation between the severity of gastroesophageal reflux disease (GERD) symptoms, acid exposure time (AET), excessive daytime sleepiness (EDS) and the level of active blood plasma ghrelin in the patients with undifferentiated connective tissue disease (UCTD). Materials and methods: The study included 120 patients with GERD. All the patients were divided in two groups: Group I - GERD was not accompanied by the signs of connective tissue disease (n=45) and Group II - GERD developed on the background of UCTD syndrome (n=75). Daily transnasal pH monitoring was performed to determine the nature of pathological refluxes. EDS was detected by The Epworth Sleepiness Scale. Active ghrelin in blood plasma samples was determined by ELISA. Results: 80% of the patients of Group II and 35.48% of Group I suffered from EDS (p<0.05). The mean daily AET index was 5.48±0.4% in Group II and 6±0.2% in Group I, in the night hours mostly when patients were in the upright position. This phenomenon contributed to a deterioration of sleep quality and the appearance of EDS and was supported by a connection between AET and EDS (r=+0.827 for Group I and r=+0.768 for Group II). The mean De Meester index was higher in the patients of Group II (23.01±2.24 in Group I vs 31.08±2.4 in Group II; p<0.05). Conclusions: GERD manifestations are strongly related to the level to AET and intensity of EDS. The EDS symptoms depend on circulating ghrelin level.

Current advances in the diagnosis and management of gastroesophageal reflux disease.

Gastroesophageal reflux disease (GERD) is very common and defined as troublesome symptoms owing to excessive acid reflux. The spectrum of GERD is broad, including not only erosive esophagitis and Barrett's esophagus but also nonerosive reflux disease (NERD), reflux hypersensitivity, and functional heartburn. Patients with reflux symptoms despite normal endoscopy remain common clinical presentation, can be heterogeneous overlapping with functional gastrointestinal disorders. Ambulatory esophageal pH monitoring with and without impedance helps the diagnosis of NERD. Metrics such as baseline impedance and postreflux swallow induced peristaltic wave enhance diagnostic accuracy in patients with inconclusive diagnoses. The major treatment of all manifestations of GERD is acid suppression with proton pump inhibitors, while other therapies, such as reflux-reducing agents and adjunctive medications, can be individualized where the response to traditional management is incomplete. GERD patients often need long-term treatment due to frequent relapses. Anti-reflux surgery can be effective too. Endoscopic therapies have some promising results, but long-term outcomes remain to be determined.

Gastroesophageal reflux disease: key messages for clinicians.

Gastroesophageal reflux disease (GERD) is a chronic common disorder for which patients often refer to specialists. In the last decades, numerous studies helped to clarify the pathophysiology and the natural history of this disease. Currently, in the clinical setting, GERD is defined by the presence of symptoms that, when endoscopic investigation is required, permit to distinguish between cases with or without associated esophageal mucosal injuries. These conditions are called erosive reflux disease and non-erosive reflux disease (NERD), respectively. The latter is the most common manifestation of GERD. Symptoms are defined typical, as heartburn and regurgitation, and atypical (also called extra-esophageal), as coughing and/or wheezing, hoarseness, sore throat, otitis media, and dental manifestations. In this context, it is crucial for clinicians to investigate the presence of features of suspected malignancy, as unexplained weight loss, anemia, dysphagia, persistent vomiting, familiar history of cancer, long history of GERD, and beginning of GERD symptoms after the age of 50 years. The presence of these risk factors should induce to perform an endoscopic examination. Particular attention should be given to functional conditions that can mimic GERD, such as functional heartburn and hypersensitive esophagus as well as, more rarely, eosinophilic esophagitis. The former ones have different pathophysiology and this explains the frequent non-response to proton pump inhibitor drugs. This narrative review provides to clinicians a useful and practical overview of the state-of-the-art on advancements in the knowledge of GERD.

Results of the study of conservative treatment of laryngeal manifestations of laryngopharyngeal reflux

Gastroesophageal reflux disease (GERD) is a disease of the gastrointestinal tract caused by the discharge of stomach contents into the esophagus. In GERD, both esophageal and extraesophageal manifestations are widespread, but, unfortunately, the latter are less well known. About one third of GERD patients have extraesophageal symptoms, which can occur even in the absence of the usual esophageal symptoms of GERD, which makes diagnosis difficult. The most common of these is laryngitis. In addition to reflux laryngitis, laryngopharyngeal reflux (LFR) can cause the development of contact granulomas, laryngeal stenosis, functional dysphonia, vocal fold nodules, Reinecke's edema, and laryngeal neoplasms. These symptoms disappear after taking antireflux therapy, but there is still no consensus on its duration.Aim. To evaluate the results of treatment of laryngeal manifestations of LFR with omeprasole 20 mg 30 minutes before meals in the morning.Methods. The study involved 531 patients with complaints of hoarseness, of which women 337 - 63.5%, men 194 - 36.5%. We prescribed omeprasole 20 mg 30 minutes before meals in the morning for 6 weeks. Patients were questioned using the Reflux Symptom Index (RSI) questionnaire and indirect laryngoscopy with an assessment of laryngeal changes according to the Reflux Signs Scale (RSS).Results. There was a statistically significant decrease in hoarseness 1 week after treatment, which continues to decrease 6 weeks after the initiation of treatment when evaluating the data on the RSI questionnaire. There was no statistically significant difference in the laryngoscopic picture before the start of treatment and after 1 week of treatment according to RSS; a statistically significant decrease in the quantitative assessment of RSS was revealed 6 weeks after the initiation of treatment.Conclusions. Omeprasole at a dose of 20 mg in 30 minutes reduces the symptoms of LFR already after 1 week, the decrease in the severity of symptoms continues by 6 weeks of its use. Improvement of the laryngoscopic picture with the appointment of omeprazole 20 mg 30 minutes before meals occurs by the 6th week of its use. A positive correlation was found between the severity of LFR symptoms, including hoarseness, and the severity of changes in the laryngoscopic picture.

Результати добового моніторингу рівня пепсину в секреті ротової порожнини дітей раннього віку із синдромом регургітації

Regurgitation syndrome in infants is one of the manifestations of gastroesophageal reflux disease (GER), which can be both an age-related physiological condition and pathological one with the risk of gastroesophageal reflux disease (GERD) developing. Differential diagnosis of GERD in infants and young children is difficult due to invasiveness and low availability of the recommended diagnostic methods, in particular esophageal pH3metry. Today, the search for new non-invasive and simple, but sensitive and specific, methods for diagnosing GERD in pediatric practice is relevant and promising. Purpose — to determine the dynamic patterns of the salivary pepsin level in young children within the framework of daily monitoring and depending on the clinical manifestations of regurgitation. Materials and methods. 55 children from 3 to 18 months were examined, among them was 38 children with visible regurgitation syndrome and 17 healthy children without clinical manifestations of the regurgitation syndrome. The intensity of regurgitation was assessed using a five-point scale «ESPGHAN». A reflux questionnaire was used for screening diagnostics of pathological GER in children. Salivary pepsin level was determined three times a day by enzyme-linked immunosorbent assay (ELISA pepsin). Statistical processing was performed using «Statistica v.6.1» software package. Results. Regurgitation syndrome was registered in all children of the main group according to their current complaints. The results of reflux questionnaire showed the following data: half of the children (52.6%) had no signs of GER, possible reflux was revealed in 31.6% of children, and probable reflux was revealed in 15.8% of children. The results of daily monitoring of salivary pepsin level in infants showed that it was significantly higher in children with regurgitation than in control group, both in terms of average daily values and intermediate values. It was found that the maximum pepsin activity in children was immediately after regurgitation. There were no significant differences between the three saliva samples and the average daily pepsin index in the children of the main group, which may indicate the presence of latent episodes of reflux during the day. Сhildren with a high risk of GERD according to the reflux questionnaire had significantly higher values of salivary pepsin on an empty stomach and its average daily level, which has sufficient specificity and predictive value according to the ROC analysis results. Conclusions. Determination of salivary pepsin levels in infants can be included in screening noninvasive tests for the GER diagnosis. The use of these tests to predict the risk of extraesophageal damage requires further study. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: regurgitation, GER, GERD, pepsin, children.

Different clinical symptom patterns in patients with reflux micro-aspiration.

BackgroundPulmonary manifestation of gastro-oesophageal reflux disease (GORD) is a well-recognised entity; however, little primary reported data exists on presenting symptoms of patients in whom reflux micro-aspiration is confirmed. The aim of this study is to report symptoms and presenting patterns of a large group of patients with confirmed reflux micro-aspiration.Patients and methodsData was extracted from a prospectively populated database of patients referred to a tertiary specialist centre with severe, refractory or atypical reflux. Patients with reflux micro-aspiration on scintigraphy were included in this study. A separate group included patients with evidence of proximal reflux to the level of pharynx when supine and/or upright.ResultsInclusion criteria were met by 243 patients with confirmed reflux micro-aspiration (33% males; mean age 59). Most common symptoms amongst patients with micro-aspiration were regurgitation (72%), cough (67%), heartburn (66%), throat clearing (65%) and dysphonia (53%). The most common two-symptom combinations were heartburn/regurgitation, cough/throat clearing, regurgitation/throat clearing, cough/regurgitation and dysphonia/throat clearing. The most common three-symptom combinations were cough/heartburn/regurgitation, cough/regurgitation/throat clearing and dysphonia/regurgitation/throat clearing. Cluster analysis demonstrated two main symptom groupings, one suggestive of proximal volume reflux symptoms and the other with motility/inflammatory bowel syndrome-like symptoms (bloat, constipation).ConclusionThe combination of typical symptoms of GORD such as heartburn or regurgitation and a respiratory or upper aero-digestive complaint such as cough, throat clearing or voice change should prompt consideration of reflux micro-aspiration.